Mental Illness Refusal To Bathe: Can It Impact Your Hygiene?

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Medically reviewed by Kimberly Langdon, MD

Mental Illness

There are many types of mental illness, all of which exhibit various signs of behavior. One common and universal sign is refusing to practice good hygiene. These areas include bathing, keeping teeth clean, wearing clean clothes, washing hair, and so forth. This sign of neglect can either be an indication of undiagnosed mental illness or one that has already been diagnosed.

How Mental Illness Can Impact Hygiene

Mental illness can cause a person to be unable or unaware of the importance of personal hygiene. Lack of cleanliness is especially prevalent among those with certain mental or emotional disorders, including severe depression, anxiety, PTSD, and psychoses. This deterioration can stem from a general apathy or lack of motivation and disorganization.

Depression in particular can cause poor hygiene. Why is this? According to Dr. Melissa A. Jones, clinical psychologist, major depression is often characterized by a diminished interest in activities as well as fatigue. Consequently, there is little motivation to take care of the basic daily tasks of washing and brushing hair and teeth.

Dr. Jones adds that the physical symptoms of depression, such as physical pain, can also cause people to avoid showering. Anxiety and sensory disorders can also cause difficulty with showering, for example. These people often will refuse to bathe as they may struggle with the temperature or touch of the water.

On the other end of the spectrum, some people with obsessive-compulsive disorder may overdo their hygiene practices like brushing their teeth several times a day or washing their hands after they touch anything. They may have a certain number or order to which they do these simple personal tasks.

What To Do If Someone Refuses to Bathe?

This can be a difficult situation, especially if this person lives with you. Depending on their mental state, coming right out and telling them they smell can be very devastating. Their reaction might be anger, confusion, or even silence.

Mental disorders are those that affect a person’s mood, feelings, thinking, and behavior. It is commonly accepted in the medical community that there are[1]seven categories:

  • mood disorders (such as depression or bipolar disorder)
  • anxiety disorders
  • personality disorders
  • psychotic disorders (such as schizophrenia)
  • eating disorders
  • trauma-related disorders (such as post-traumatic stress disorder)
  • substance abuse disorders

Refusing to bathe is a phobia classified as an anxiety disorder. According to the American Psychiatric Association[2], about 8 to 12 percent of adults in the United States have a specific phobia. Refusing to bathe is a phobia called ablutophobia in which individuals have an irrational fear of bathing or washing. This occurs more often in women. They know they have this unrealistic fear but are unable to overcome it.

Recognizing Hygiene as a Sign of Mental Illness

So how do you know if someone’s hygiene practices are normal or a sign of mental illness? This is a tough question as we all have different expectations of what is normal. Do we wait for someone to tell them their breath smells bad or do they need deodorant?

The most prevalent symptom of people with ablutophobia is fear. To diagnose this phobia, the person must have this fear for at least 6 months or longer. Since this is a type of anxiety disorder, physical symptoms associated with ablutophobia often include a racing pulse, heart palpitations, difficulty breathing, dizziness, and sudden sweats.

If you or someone you know are depressed or anxious, it may be normal to forget some daily hygiene practices. However, if this goes on for a long time, you may need to find a therapist to talk to. Don’t be embarrassed. Diagnosing mental illness from strange hygiene practices may be difficult but not impossible. Because poor hygiene is common among those with mental illness, therapists can easily diagnose and make suggestions for this particular situation.

How Does Someone Get Ablutophobia?

Even today, doctors and researchers don’t completely understand why people have developmental disorders. Some causes may be related to the following:

  • Genetics or a family history of the disorder
  • Chemical imbalance in the brain
  • Substance abuse
  • Trauma during childhood like almost drowning in a bathtub
  • Stressful circumstances during childhood, such as threats for not bathing or making fun if they are always dirty
  • Poverty and low levels of social support

What Can You Do?

There are several things you can do to help someone cope with a phobia like fear of bathing.

  1. Try to find out why the person does not want to bathe.
  2. Explain the reasons for bathing or showering.
  3. Mention the possibility of infection, skin problems, or other diseases due to lack of bathing.
  4. Make sure other family members or friends understand the phobia.
  5. Suggest attending a support group of people with phobias.
  6. Talking with others who fear bathing might help this person understand they are not alone.
  7. Suggest therapy to the person.
  8. Avoid caffeine which is known to cause anxiety disorders such as phobias.
  9. Research natural remedies for helping the person relax.
  10. Discuss medications with a therapist.

Diseases Caused by Poor Hygiene 

Discussing the different diseases and health conditions that can result from refusing to bathe might also help the person understand the importance of changing their behavior. If this is a true anxiety phobia, however, this discussion may not be beneficial. Such conditions include[3]:

  • Athlete’s Foot
  • Body Lice
  • Chronic Diarrhea
  • Dental Caries
  • Dermatitis
  • Head Lice
  • Pinworms
  • Pubic Lice
  • Scabies
  • Tooth Decay

Available Treatments

Behavioral Therapy

In the past, mental illness has been mainly treated using psychoanalysis, a long process often lasting years and involving two or more sessions a week. First used by Sigmund Freud during the 1890s, psychoanalysis focuses on unseen desires and motivations housed in the unconscious mainly from past memories and traumas.

Today, other therapeutic approaches[4] have been created that can help people change the way they monitor, think about, and respond to their feelings and the world around them. Most popular is behavior therapy which focuses on actions that can be seen now.

Cognitive-behavioral therapy or CBT is one of these approaches. Created by psychologist Aaron Beck, CBT is a type of talk therapy, also known as psychotherapy, and is believed to be the most effective for treating anxiety disorders.

Studies of CBT have shown it to be an effective treatment for a wide variety of mental illnesses, including depression, anxiety disorders, bipolar disorder, eating disorders, and schizophrenia.

In the case of individuals with ablutophobia, they can learn how to manage their emotional reactions which can then help them live with this phobia and bring it under control. CBT helps about 75 percent of people with specific phobias find relief.

Exposure Therapy

Exposure therapy is done in a controlled environment and has been used effectively with people suffering from ablutophobia. This might mean they first simply turn on a shower and watch it while fully clothed. Then step into a shower fully clothed. Then gradually work up to more complete and longer bathing experiences, eventually without clothes. An alternative to this approach might be a sponge bath.

Medications

Medications can be helpful, especially when other forms of therapy have been ineffective, or someone has other psychiatric issues that require separate treatment. Anti-anxiety drugs and antidepressants can help but only under a doctor’s care as these can have strong side effects.

Conclusion

Suffering from a phobia such as ablutophobia can be very stressful for those who live with this on a daily basis. Because this is an anxiety phobia, getting professional help is the best way to understand and change this behavior. For the person or the caregiver, choosing the right form of therapy and therapist may be the best action to take to give eventual relief to the person suffering.


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  1. Cunha, J.P. (2020). What Are Seven Common Types of Mental Disorders? [online] eMedicineHealth. Available at: https://www.emedicinehealth.com/what_are_seven_common_types_of_mental_disorders/article_em.htm
  2. Psychiatry.org. (2021). What Are Anxiety Disorders? [online] Available at: https://www.psychiatry.org/patients-families/anxiety-disorders/what-are-anxiety-disorders
  3. ‌Anon, (2021). Hygiene-related Diseases. [online] Available at: https://www.cdc.gov/healthywater/hygiene/disease/index.html
  4. ‌Nami.org. (2021). Psychotherapy | NAMI: National Alliance on Mental Illness. [online] Available at: https://www.nami.org/About-Mental-Illness/Treatments/Psychotherapy

Medically reviewed by:

Sandra Cesca is a freelance healthcare writer with many year’s experiences working in the health industry. She covers allopathic, naturopathic, holistic, and complementary medicine. Sandra is also a cultural photographer and tour guide living her dream in tropical Puerto Vallarta, Mexico.

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